2015
EMS Protocol
Training Module
2014 - 15 EMS Protocol Committee
Overview of Changes
 New Format
 Addition of an Appendix section
 Addition of the Initial Treatment / Universal
Patient Care Protocol
 BLS Protocol Additions / Deletions / Revisions
 Deletion of MAMP and TAMP
 Addition of 6102 Spinal Immobilization
 Revision of 6110 Burns
1
Overview of Changes
 Addition of 6214 Return of Spontaneous Circulation – ROSC
 Revision of 6302 Bronchospasm
 Revision of 6501 Allergic Reaction / Anaphylaxis
 Revision of 6504 Snake Bite
 Revision of 6605 Unconscious / Altered Mental Status
 Revision of 6606 Overdose / Ingestion / Poisoning
 Revision of 6607 Behavioral Emergencies / Patient Restraint
 Addition of 6700 series - Children with Special Healthcare
Needs
 Addition of 7000 series - BLS Procedural Protocols
2
Overview of Changes
 BLS Medication Additions / Deletions / Revisions
 Addition of Combi-vent / Duo-Neb (Albuterol and Atrovent
combined)
 Addition of Narcan®
 Addition of Zofran® ODT
 Addition of Tetracaine
 Removal of Activated Charcoal
 ALS Protocol Additions / Deletions / Revisions
 Deletion of MAMP and TAMP
 Addition of 4102 Spinal Immobilization
 Revision of 4110 Burns
 Addition of 4111 Eye Injuries
3
Overview of Changes
 Revision of 4202 Chest Pain Discomfort / ACS
 Revision of 4203 Severe Hypertension
 Revision of 4205 Cardiac Arrest
 Revision of 4208 Adult Tachycardia
 Addition of 4214 Return of Spontaneous Circulation – ROSC
 Revision of 4302 Bronchospasm
 Revision of 4303 Pulmonary Edema
 Revision of 4501 Allergic Reaction / Anaphylaxis
 Revision of 4504 Snake Bite
 Revision of 4602 Stroke / TIA
 Revision of 4603 Seizures
4
Overview of Changes
 Revision of 4604 Diabetic Emergencies
 Revision of 4605 Unconscious / Altered Mental Status
 Revision of 4606 Overdose / Ingestion / Poisoning
 Revision of 4607 Behavioral Emergencies / Patient
Restraint
 Addition of 4700 series Children with Special
Healthcare Needs
 Revision of 4902 Patient Comfort / Pain Management
 Addition of 4903 Rapid Sequence Intubation
 Revision of 8000 series ALS Procedural Protocols
 Addition of 9203 LVAD
5
Overview of Changes
 ALS Medication Additions / Deletions / Revisions
 Addition of Combi-vent / Duo-Neb (Albuterol and Atrovent
combined)
 Addition of Magnesium Sulfate
 Addition of Zofran® ODT
 Addition of Midazolam
 Addition of Tetracaine
 Addition of Diltiazem
 Addition of Labetalol
 Addition of Haloperidol
 Addition of Etomidate (Approved RSI squads ONLY)
 Addition of Succinylcholine (Approved RSI squads ONLY)
 Addition of Vecuronium (Approved RSI squads ONLY)
6
Overview of Changes
 ALS Medication Additions / Deletions / Revisions
 Removal of Activated Charcoal
 Removal of Toradol®
 Reclassification of Sodium Bicarbonate to optional
 Removal of Lorazepam
 Removal of Ipratropium Bromide (Atrovent ®) by itself
7
Purpose of Training
 This training is designed to familiarize the EMS
provider with use and content of the revised
protocols.
 All EMS providers shall be responsible to read and
review each protocol in its entirety.
 These protocols are to utilized as a guide to patient
care and are not designed to be a teaching tool.
 Most of the protocols have change in some
capacity. Some minor and some major.
8
Utilizing the Protocols
 The West Virginia EMS Statewide Protocols are
designed to enable EMS personnel to provide a
wide variety of treatments to many types of
patients. Understanding the organization and
terminology of the protocols is important and
will vastly improve the usability by the EMS
provider.
 These protocols have been accepted by the
MPCC to move West Virginia forward and better
the care we provide to our patients.
9
Utilizing the Protocols
 A new look
 Header:
 Footer:
10
Utilizing the Protocols
Classifications of Levels of Care: (first digit)
 1000
 2000
 3000
 4000
 5000
 6000
- CCT-RN
- CCT-Paramedic
- C3-IFT (Inter-facility Transport Paramedic)
- Paramedic
- Open
- EMT
7, 8 and 9 thousand series are used as follows:
 7000 - BLS Procedural Protocols
 8000 - ALS Procedural Protocols
 9000 - Special Operational Policies and Protocols
11
Utilizing the Protocols
Category of Care: (second digit)
 4100
 4200
 4300
 4400
 4500
 4600
 4700
 4800
 4900
- Trauma
- Cardiac
- Respiratory
- Pediatrics
- Environmental
- Medical
- Special Healthcare Needs
- Open
- Special Treatment Protocols
12
Utilizing the Protocols
 Shaded boxes with icons indicate that specific
contact is required with Medical Command (red
telephone) or the Medical Command Physician
(physician) in order to perform specific
treatments.
13
Utilizing the Protocols
 For the purposes of these protocols, any patient
under the age of 12 years will be considered a
pediatric patient. Certain patients who are
larger or smaller than the norms for their age
may require modification of treatment.
Providers should consult with Medical
Command as needed in making this
determination.
14
Utilizing the Protocols
 In addition to this protocol release, the Scope of
Practice as well as the Required Equipment List
has been updated.
 Equipment that is directly related to patient care is
required to be approved by the MPCC. Equipment
not listed on the equipment list that is directly
incorporated into patient care is prohibited
without MPCC approval.
15
16
Initial Treatment / Universal Patient Care
 The Initial Treatment / Universal Patient Care
Protocol is the first protocol within these guidelines
and replaces MAMP and TAMP.
 It is to be used universally on all patients as a
starting point for assessment and treatment prior
to moving on to a specific protocol.
 This protocol is designed to establish support at the
beginning of patient care while identifying specific
signs and symptoms that will direct the EMS
provider to a more complaint specific protocol.
17
Initial Treatment / Universal Patient Care
 The Initial Treatment / Universal Patient Care
protocol is designed to guide the EMS provider in
the initial and ongoing approach to assessment
and management of medical and trauma patients.
 Components of the Initial Treatment / Universal
Patient Care Protocol:
 Scene Size Up
 Primary Survey
 Secondary Survey
18
19
6101-Severe External Bleeding
20
6101-Severe External Bleeding
 This protocol was adjusted to incorporate the use
of tourniquets appropriately.
 The use of the Patient Comfort / Pain
Management Protocol has been added.
 Hemostatic agents were changed to be optional
equipment.
21
6102-Spinal Immobilization
22
6102-Spinal Immobilization
 New Protocol
 Spinal Immobilization is indicated in patients who
have been exposed to a mechanism that could
cause spinal injury.
 This protocol will guide the EMS provider in the
decision to perform or not to perform spinal
immobilization.
 If the EMS provider has any doubt after working
through this protocol...Perform Immobilization!
23
6103-Spinal Trauma
 This protocol indicates treatment for patients who
have suffered spinal trauma.
 This protocol may or may not be utilized in
conjunction with 6102 Spinal Immobilization.
 Low Risk and High Risk criteria have been added:
 Low Risk Mechanisms
 High Risk Mechanisms
 Nexus Criteria
24
6110-Burns
 This protocol was revised to combine multiple
protocols into one.
 NEVER ATTEMPT TO REMOVE PATIENT FROM AN
IMMEDIATELY DANGEROUS TO LIFE AND HEALTH
(IDLH) ENVIRONMENT UNLESS TRAINED,
CERTIFIED, AND PROPERLY EQUIPPED. NEVER
PLACE YOURSELF OR YOUR CREW IN DANGER.
Decontamination, if necessary, should be done by
appropriate certified personnel.
25
6110-Burns
 This protocol will guide the EMS provider in the
following:
 Thermal Burns
 Dry Chemical Burns
 Liquid Chemical Burns
 Major and Minor Burn Criteria:
26
6110-Burns
 Rule of Nines added to protocol:
27
6205-Adult Cardiac Arrest
28
6205-Adult Cardiac Arrest
 6214 ROSC protocol added as the end component
 Reversible causes added:
29
6214-Return Of Spontaneous Circulation
 New Protocol
 Components of 6214 Return Of Spontaneous
Circulation / ROSC Protocol:
 Follow the Initial Treatment / Universal Treatment Protocol
 Assist Ventilations as needed
 Consider ALS assist
 Continually reassess ABC’s
 Contact Medical Command for additional treatment
30
6302-Bronchospasm
 Protocol revised to define minimal, moderate,
and severe distress.
 Initial treatment medication changed to Albuterol
and Ipratropium Bromide combined
(Combi-Vent / Duo-Neb) unless contraindicated.
 Initial treatment is a standing order.
 Second dose of medication requires MCP order.
 Epinephrine 1:1000 added to protocol in cases of
continued severe distress in patients < 35 years
old with MCP order.
31
6303-Pulmonary Edema
 New Protocol.
 In patients with severe distress, consider CPAP if
available per protocol 7301.
 If wheezing is evident: administer Albuterol and
Ipratropium Bromide combined (Combi-Vent /
Duo-Neb) standing order for first dose unless
contraindicated.
32
6410-Newborn Infant Care
 Addition of the Apgar Scoring Chart:
33
6412-Allergic Reaction / Anaphylaxis (Ped.)
 Protocol revised to define minimal, moderate, and
severe distress.
 Epinephrine 0.3 mg 1:1000 IM added as an alternative
to the optional Epi Pen Jr.® per MCP order.
 If symptoms continue or worsen after initial treatment;
Albuterol may be administered per MCP order. CombiVent / Duo-Neb Shall Not be utilized in pediatric
patients.
34
6501-Allergic Reaction / Anaphylaxis (Adult)
 Protocol revised to define minimal, moderate, and
severe distress.
 Epinephrine 0.3 mg 1:1000 IM added as an
alternative to the optional Epi Pen®.
 If symptoms continue or worsen after initial
treatment; Albuterol combined with Ipratropium
Bromide (Combi-Vent / Duo-Neb), unless
contraindicated, may be administered per MCP
order.
35
6504-Snake Bite / Envenomation
 Protocol revised to include Item E. The EMS
provider shall locate the fang puncture(s) and
mark with a pen the edge of erythema (redness
around bite mark). This should be done at the
initial assessment and every five (5) minutes
thereafter.
36
6604-Diabetic Emergencies
 Hypoglycemia treatments shall relate to blood
glucose levels < 60 mg/dl.
 Administer oral glucose ONLY to patients who can
maintain an open airway.
 In patients that are not conscious or cannot
maintain an open airway, simply secure the airway
and request ALS assist and consult Medical
Command.
37
6605-Unconscious/Altered Mental Status
 The use of this protocol requires the patient to
have a Glasgow Coma Score < 12.
 This protocol is intended to guide the
management of patients with a decreased level of
consciousness who have no history of trauma.
 Patients who exhibit with a blood glucose
level > 60 mg/dl but remain unconscious or with
an altered mental status; may be administered
Naloxone 2 mg intranasal via atomizer per MCP
order.
38
6605-Unconscious/Altered Mental Status
 Possible causes added as follows:
39
6606-Overdose/Toxic Ingestion/Poisoning
 This protocol was revised to combine multiple
protocols into one.
 Protocol incorporates the following:
 Alcohol
 Narcotics / Opiates
 Patients who exhibit with a blood glucose level > 60
mg/dl and have suspected narcotic overdose
complicated by respiratory depression; may be
administered Naloxone 2 mg intranasal via atomizer
per MCP order.
40
6606-Overdose/Toxic Ingestion/Poisoning
 Examples: Morphine, Heroin, Demerol, Dilaudid,
Methadone, Fentanyl, Oxycodone, Codeine, and others.
 Tricyclic Antidepressants
 Examples: Amitriptyline (Elavil®), Amoxapine (Asendin®),
Clomipramine (Anafranil®), Doxepin (Sinequan®,
Adepin®), Imipramine (Tofranil®) and Nortriptyline.
 Cholinergics
 Examples: Pesticides (Organophosphates, Carbamates)
and nerve gas agents (Sarin, Soman) are the most
common exposures.
41
6606-Overdose/Toxic Ingestion/Poisoning
 Calcium Channel Blockers
 Examples: Verapamil (Calan®, Isoptin®), Nifedipine
(Procardia®, Procardia XL®, Adalat®, Adalat CC®),
Nicardipine (Cardene®, Carden SR®), Isradipine
(DynaCirc®, DynaCirc SR®), Amlodipine (Norvasc®),
Nisoldipine (Sular®), Diltiazem (Cardizem®, Dilacor XR®,
Tiamate®, Teczem®, and Tiazac®), and Bepridil (Vascor®).
 Beta Blockers
 Examples: Atenolol (Tenormin®), Betaxolol (Kerlone®,
Betoptic®), Carteolol (Cartrol®), Carvedilol (Coreg®),
Labetalol (Trandate®, Normodyne®), Metoprolol
(Lopressor®, Toprol XL®), Propranolol (Inderal®,
InnoPran®), Sotalol (Betapace®), Timolol (Blocadren®).
42
6606-Overdose/Toxic Ingestion/Poisoning
 Stimulants
 Examples: Cocaine (Coke, crack, flake, rocks,
snow),Methamphetamine (Desoxyn, crank, glass, ice,
speed), Methylphenidate (Ritalin®),
Methylenedioxyamphetamine (MDA, Adam),
Methylenedioxymethamphetamine (MDMA, Eve,
Ecstasy), Methylenedioxypyrovalerone (Bath Salts, Ivory
Wave, Ivory Coast, Purple Wave, Vanilla Sky)
43
6607-Behavioral Emergencies
 This protocol was revised to incorporate the SAFER
mnemonic:
 Stabilize the situation by containing and lowering the
stimuli.
 Assess and acknowledge the crisis.
 Facilitate the identification and activation of resources.
 Encourage patient to use resources and take actions in
his/her best interest.
 Recovery or referral: leave patient in care of responsible
person or professional.
 Commercially available soft restraints are
permitted for patient restraint.
44
6608-OB/GYN
 Addition of the Apgar Scoring Chart:
45
6609-Nausea/Vomiting
 This new protocol is designed to guide the BLS
provider in treating patients with nausea and/or
vomiting.
 The BLS provider may administer Ondansetron
(Zofran®) 4 mg tablet dissolved in the mouth by
standing order. Repeat doses require Medical
Command order.
46
6700 Series
 The 6700 series has been added to guide the EMS
provider in care for Children with Special
Healthcare Needs. (CSHCN)
 This series will evolve in future protocol revisions
to incorporate adults with special healthcare
needs as well.
 Children with Special Health Care Needs (CSHCN)
can present unique challenges for providers. The
caregiver is your best source of information as
they care for the child on a daily basis.
47
6700 Series
 The EMS provider needs to have a working
knowledge of the Pediatric Assessment Triangle
(PAT) as it is a general reference for each of the
6700 series protocols.
Appearance
Work of Breathing
Circulation of Skin
 The EMS provider shall read and understand the
content of each of the 6700 series protocols.
48
6700 Series
 The 6700 Series CSHCN protocols consist of the
following:
6701 General Assessment
6702 Central Venous Lines
6703 CSF Shunt
6704 Feeding Tubes
6705 Apnea Monitors
6706 Internal Pacemaker / Defibrillator
6707 Ventilator Support / BiPap
49
7000 Series
 The 7000 series protocols are a new addition to
incorporate BLS Procedural Treatments.
 The 7000 Series consists of the following:
7102 Morgan Lens (optional)
 The Morgan Lens is a BLS skill and training shall be
provided by the Squad Training Officer prior to use.
 The BLS provider may administer 2 drops of Tetracaine
prior to irrigation.
50
7000 Series
7301 Continuous Positive Airway Pressure (CPAP)
 CPAP has been shown to rapidly improve vital signs, gas
exchange, work of breathing, decrease the sense of
dyspnea, and decrease the need for endotracheal
intubation in certain patients who suffer respiratory
distress from CHF, pulmonary edema, asthma, COPD, or
pneumonia.
 In patients with CHF, CPAP can improve hemodynamics
by reducing preload and afterload, however it may
cause hypotension.
51
7000 Series
7403 STOMA / Tracheostomy Suction Management
 The majority of adults and children with tracheostomies
are dependent on the tube as their primary airway. In
patients with CHF.
 Obstruction may be due to thick secretions, mucous
plug, blood clot, foreign body, or kinking or
dislodgement of the tube. Work expeditiously and
deliberately to reestablish airway patency and support
oxygenation/ventilation.
 DO NOT wait for cyanosis, bradycardia, and/or apnea to
develop before intervening.
52
7000 Series
 Tracheal suctioning should be carried out regularly for
patients with a tracheostomy. The frequency varies
between patients and is based on individual
assessment.
 Tracheal damage may be caused by suctioning. This can
be minimized by using the appropriate sized suction
catheter and only suctioning within the tracheostomy
tube.
53
9000 Series
The 9000 series Special Operational Policies and Treatment
Protocols have minimal changes throughout consisting
mostly of format and grammatical corrections.
9203 Left Ventricular Assist Device (LVAD) was added as an
informational protocol to assist the EMS provider in
treatment priorities when encountering these patients.
When treating an LVAD patient it is critical to listen to
the patient and the caregiver.
LVAD patients should rarely have CPR performed.
LVAD patients are rarely pronounced in the field.
There will always be an emergency contact number on
the LVAD control unit.
LVAD patients require transport to an LVAD facility.
54
Appendix
The 2015 protocols have an appendix section that can be
easily amended when necessary.
The appendix section consist of the following:
Appendix A – Fibrinolytic Checklist
Appendix B – Diversion Alert Status Form
Appendix C – Pediatric References
Appendix D – Assessment Mnemonics
Appendix E – Glasgow Coma Scale
Appendix F – Approved Abbreviations
Appendix G – Cincinnati Pre-hospital Stroke Scale
Appendix H – EMS Patient Care without
Telecommunications
55
56
Ondansetron (Zofran®)
 Class: Antiemetic, Serotonin Receptor Antagonist
 Dosage: 4mg tablet dissolved in the mouth.
 Actions: Antiemetic - The mechanism by which
Ondansetron works to control nausea and
vomiting is not fully understood; it is believed that
the antiemetic properties occur as a result of
serotonin receptor antagonism.
 Indications: Adults with nausea and vomiting.
57
Ondansetron (Zofran®)
 Contraindications: History of allergic reaction to
Ondansetron or to any medicine similar to
Ondansetron, including Dolasetron (Anzemet),
Granisetron (Kytril), or Palonosetron (Aloxi).
 Side Effects: Constipation, diarrhea, dry mouth,
headache, dizziness, drowsiness/sedation,
Anaphylaxis (rare), fatigue, malaise, chills, cardiac
dysrhythmia (rare), hypotension, bronchospasm,
muscle pain.
58
Combi-Vent / Duo-Neb
 Class: Sympathomimetic, Parasympatholitic
 Dosage: Is a unit dose of Albuterol 2.5 mg mixed
with a unit dose of Ipratropium Bromide 0.5 mg
(Combi-vent / Duo-Neb®) via nebulizer.
 Actions: Combination of beta2 and anticholenergic
effects.
 Indications: Relief of bronchospasm in adult
patients with reversible obstructive airway disease
and acute attacks of bronchospasm.
59
Combi-Vent / Duo-Neb
 Contraindications: Prior hypersensitivity to any of
its components or to atropine, soy lecithin,
bromide or flourocarbons and cardiac
dysrhythmias associated with tachycardia.
 Side Effects: Restlessness, apprehension, dizziness,
headache, blurred vision, dry mouth, palpitations,
increase in BP, dysrhythmias, increased hypoxemia.
60
Tetracaine
 Class: Topical ophthalmic anesthetic
 Dosage: 2 drops in the affected eye prior to
irrigation.
 Actions: Superficial anesthesia. Inhibits
conduction of nerve impulses from sensory
nerves.
 Indications: Patient comfort prior to eye irrigation.
61
Tetracaine
 Contraindications: Known hypersensitivity or open
globe injury (i.e. laceration to the eyeball).
 Side Effects: Burning or stinging sensation,
irritation, and possible epithelial damage and
systemic toxicity.
62
Naloxone (Narcan®)
 Class: Synthetic opioid antagonist
 Dosage: 2 mg administer intranasal (IN) via
atomizer. Administration should be delivered 1 mg
per nostril.
 Actions: Reverses all effects due to opioid
(morphine-like) agents. This drug will reverse the
respiratory depression and all central and
peripheral nervous system effects.
63
Naloxone (Narcan®)
 Indications: To reverse respiratory and central
nervous system depression induced by opiates.
 Contraindications: Not clinically significant.
 Side Effects: Naloxone may induce opiate
withdrawal in patients who are physically
dependent. Patients may also exhibit with
tachycardia, nausea, vomiting, hypertension, and
diaphoresis.
64
65
4101-Severe External Bleeding
66
4101-Severe External Bleeding
 This protocol was adjusted to incorporate the use
of tourniquets appropriately.
 The use of the Patient Comfort / Pain
Management Protocol has been added.
 Hemostatic agents were changed to be optional
equipment.
67
4102-Spinal Immobilization
68
4102-Spinal Immobilization
 New Protocol
 Spinal Immobilization is indicated in patients who
have been exposed to a mechanism that could
cause spinal injury.
 This protocol will guide the EMS provider in the
decision to perform or not to perform spinal
immobilization.
 If the EMS provider has any doubt after working
through this protocol...Perform Immobilization!
69
4103-Spinal Trauma
 This protocol indicates treatment for patients who
have suffered spinal trauma.
 This protocol may or may not be utilized in
conjunction with 4102 Spinal Immobilization.
 Low Risk and High Risk criteria have been added:
 Low Risk Mechanisms
 High Risk Mechanisms
 Nexus Criteria
70
4108-Hypoperfusion / Shock
 The initial Dopamine drip has been revised to
start at 5 micrograms/kg/min per MCP order.
 The Dopamine drip may then be titrated at 5 20 micrograms/kg/min in an effort to an effort
to improve perfusion per MCP order.
71
4110-Burns
 This protocol was revised to combine multiple
protocols into one.
 NEVER ATTEMPT TO REMOVE PATIENT FROM AN
IMMEDIATELY DANGEROUS TO LIFE AND HEALTH
(IDLH) ENVIRONMENT UNLESS TRAINED,
CERTIFIED, AND PROPERLY EQUIPPED. NEVER
PLACE YOURSELF OR YOUR CREW IN DANGER.
Decontamination, if necessary, should be done by
appropriate certified personnel.
72
4110-Burns
 This protocol will guide the EMS provider in the
following:
 Thermal Burns
 Dry Chemical Burns
 Liquid Chemical Burns
 Major and Minor Burn Criteria:
73
4110-Burns
 Rule of Nines added to protocol:
74
4111-Eye Injuries
 New Protocol for ALS
 This protocol is a simple guide to treatment of eye
injuries that previously was absent from the ALS
protocols.
 This protocol includes:
 Penetrating Trauma
 Ultraviolet light exposure
 Loss of vision
75
4202-Chest Pain Discomfort / ACS
 The administration of Aspirin was moved to early
on in the protocol.
 The administration of Morphine has been changed
to a standing order of 2 mg every 5 minutes to a
total dose of 10 mg or relief of pain. In the
presence of hypotension or bradycardia the ALS
provider should consider the use of Fentanyl.
 The protocol was revised to incorporate a standing
order for Fentanyl at 50 micrograms repeated
every 5 minutes to a total dose of 150 micrograms.
76
4202-Chest Pain Discomfort / ACS
77
4203-Severe Hypertension
 This protocol is a complete rewrite.
 This protocol is utilized in patients that have a
systolic BP > 240 mm/hg and/or a diastolic BP >
120 mm/hg. These pressures must be taken
manually and repeated in opposing arms.
 The treatment goal is to reduce the MAP by 10 15% of the initial value. DO NOT reduce BP to
normal range in these patients.
78
4203-Severe Hypertension
 Treatment of hypertension requires two successive
readings of a systolic BP > 240 mm/hg and/or a
diastolic BP > 120mm/hg.
 Consider intervention if patient is symptomatic per
MCP order.
 Treatment per MCP order includes the following:
 Labetalol: 10 mg over two (2) minutes repeated in 10
minutes at 20 mg.
 Nitroglycerin: 0.4 mg SL every 3 - 5 minutes to a maximum
of 1.2 mg.
 Morphine: 2 - 10 mg.
79
4205-Adult Cardiac Arrest
80
4205-Adult Cardiac Arrest
 4214 ROSC protocol added as the end component.
 Reversible causes added:
 Sodium Bicarbonate classified as optional for
treatment of reversible causes.
81
4205-Adult Cardiac Arrest
 Protocol indicates the administration of
Amiodarone 300 mg and treatment of reversible
causes. Consider 150 mg dose if no conversion in
3 - 5 min.
 May substitute Lidocaine 1.0 - 1.5 mg/kg IV/IO
repeated at 0.5 - 0.75 mg/kg IV/IO at 10 min.
intervals to a max dose of 3 mg/kg.
 In cases of Torsades administer Magnesium
Sulfate 1 gram diluted in 10 ml NS over 5 - 20
minutes.
82
4208-Adult Tachycardia
83
4208-Adult Tachycardia
 The revised protocol begins with a HR > 150 bpm
and one of the following: BP < 90 mm/hg or
altered level of consciousness. (The old protocol
required all three).
 In cases of SVT the protocol has changed to
administration of Adenosine 6 mg repeated at 12
mg one (1) time.
84
4208-Adult Tachycardia
 In cases of Atrial Fibrillation, Atrial Flutter, or SVT
with no conversion after Adenosine; administer
Diltiazem (Cardizem®) 0.25 mg/kg slow IVP
repeated in 15 minutes at 0.35 mg/kg slow IVP
Per MCP order.
85
4211-Symptomatic Bradycardia
 In patients that require Transcutaneous Pacing,
consider pre-medication with Midazolam
(Versed®) 2 mg.
 The protocol now includes a standing order for
Fentanyl (Sublimaze®) 50 micrograms slow IV
repeated at 50 micrograms every 5 minutes not
to exceed a total cumulative dose of 150
micrograms for pain management during TCP.
86
4214-Return Of Spontaneous Circulation
 New Protocol
 Components of 4214 Return Of Spontaneous
Circulation / ROSC Protocol:
 Follow the Initial Treatment / Universal Treatment Protocol.
 Assist Ventilations as needed.
 Consider reversible causes.
 Continually reassess ABC’s.
 If the patient remains unconscious consider cooling with
cool IV fluid (if available) and cold packs applied to the
groin, neck, and axilla.
 Contact Medical Command for additional treatment.
87
4214-Return Of Spontaneous Circulation
 The protocol also defines post resuscitation
treatment as follows: Consider the administration
of Amiodarone Infusion or Lidocaine infusion if
the patient was resuscitated following an episode
of VF/VT and is without profound bradycardia or
high-grade heart block (2nd degree Type II or 3rd
degree or idioventricular rhythm) Per MCP order.
Note: Continue using the anti-arrhythmic
medication that was administered during
resuscitation.
88
4302-Bronchospasm
 Protocol revised to define minimal, moderate, and
severe distress.
 Initial treatment medication changed to Albuterol
and Ipratropium Bromide combined (Combi-Vent /
Duo-Neb) standing order if not contraindicated.
 Second dose of medication requires MCP order.
 Epinephrine 1:1000 added to protocol in cases of
continued severe distress in patients < 35 years old
with MCP order.
89
4303-Pulmonary Edema
 This protocol is a complete rewrite.
 If patient has rales along with JVD and initial
blood pressure is > 180 systolic; administer
Nitroglycerine 0.4 mg every 3 – 5 minutes up to a
total of three (3) doses or 1.2 mg.
 Obtain a manual BP between doses of
Nitroglycerine.
90
4303-Pulmonary Edema
 If the patient has taken Sildenafil (Viagra®) or
Vardenafil (Levitra®) within last 24 hours, or
Tadalafil (Cialis®) within the last 72 hours
Nitrogycerin should be withheld and treat as
follows:
 If patient DOES NOT currently take Furosemide (Lasix);
administer Furosemide 40 mg IV/IO standing order.
 If patient DOES currently take Furosemide (Lasix);
administer Furosemide 80 mg IV/IO standing order.
91
4402- Pediatric Hypoperfusion / Shock
 The initial Dopamine drip has been revised to
start at 5 micrograms/kg/min per MCP order.
 The Dopamine drip may then be titrated at
5 - 20 micrograms/kg/min in an effort to an
effort to improve perfusion per MCP order.
92
4403-Pediatric Seizure
 In the pediatric seizure patient suspected of
hypoglycemia (blood glucose < 60 mg/dl); treat as
follows:
 Patient 1 month of age or younger – If blood glucose is < 60
mg/dl, administer 5.0 -10.0 ml/kg Dextrose 10% IV/IO (D10
is prepared by mixing 40 ml of NS with 10 ml of D50W).
 Patient older than 1 month but younger than 2 years old –
If blood glucose is < 60 mg/dl, administer 2 - 4 ml/kg of
D25 IV/IO; (D25 is prepared by mixing 25 ml NS with 25 ml
D50W).
 Patient 2 years of age or older - If blood glucose is < 60
mg/dl, administer D50W 1 - 2 ml/kg IV/IO. Maximum dose
is 25 grams.
93
4403-Pediatric Seizure
 In the pediatric seizure patient with abnormal
glucose levels and no IV, Glucagon may be
administered as follows:
 Patient < 20 kg, administer Glucagon 0.5 mg IM standing
order.
 Patient > 20 kg, administer Glucagon 1 mg IM standing
order.
94
4403-Pediatric Seizure
 If seizure lasts longer than five (5) minutes or two
(2) or more episodes of seizure activity occur
between which the patient does not regain
consciousness:
 Administer Midazolam (Versed®) IV/IO 0.1 mg/kg per MCP
order.
 If no IV access is available, administer Midazolam
(Versed®) 0.2 mg/kg intranasal (IN) via atomizer per MCP
order.
95
4410-Newborn Infant Care
 Addition of the Apgar Scoring Chart:
96
4411-Pediatric Diabetic Emergencies
 In the pediatric diabetic patient suspected of
hypoglycemia (blood glucose < 60 mg/dl); treat as
follows:
 Patient 1 month of age or younger – If blood glucose is < 60
mg/dl, administer 5.0 - 10.0 ml/kg Dextrose 10% IV/IO (D10
is prepared by mixing 40 ml of NS with 10 ml of D50W).
 Patient older than 1 month but younger than 2 years old –
If blood glucose is < 60 mg/dl, administer 2 - 4 ml/kg of
D25 IV/IO; (D25 is prepared by mixing 25 ml NS with 25 ml
D50W).
 Patient 2 years of age or older – If blood glucose is < 60
mg/dl, administer D50W 1 - 2 ml/kg IV/IO. Maximum dose
is 25 grams.
97
4412-Allergic Reaction / Anaphylaxis (Ped.)
 Protocol revised to define minimal, moderate, and
severe distress.
 Pediatric patients in minimal distress may be
administered Diphenhydramine (Benadryl®)
1 mg/kg maxed at 25 mg as a standing order.
 Patients in moderate to severe distress shall be
administered Epinephrine 1:1000 as follows:
 Epinephrine 0.3 mg IM for patients > 30 kg standing order.
 Epinephrine 0.15 mg IM for patients < 30 kg standing order.
98
4501-Allergic Reaction / Anaphylaxis (Adult)
 Protocol revised to define minimal, moderate, and
severe distress.
 Adult patients in mild distress may be
administered Diphenhydramine (Benadryl®)
25 mg slow IV/IO or IM repeated in 30 minutes if
no improvement as a standing order.
 If symptoms continue or worsen after initial
treatment; Albuterol combined with Ipratropium
Bromide (Combi-vent / Duo-Neb) may be
administered standing order if not
contraindicated.
99
4504-Snake Bite / Envenomation
 Protocol revised to include Item F. The EMS
provider shall locate the fang puncture(s) and
mark with a pen the edge of erythema (redness
around bite mark). This should be done at the
initial assessment and every five (5) minutes
thereafter.
100
4603-Seizures
 In the seizure patient suspected of hypoglycemia
(blood glucose < 60 mg/dl), treat per 4604
Diabetic Emergencies Protocol.
 If seizure lasts longer than five (5) minutes or two
(2) or more episodes of seizure activity occur
between which the patient does not regain
consciousness, administer:
 Midazolam (Versed®) 2 mg IV/IO standing order.
 If no IV access is available, administer Midazolam
(Versed®) 5 mg intranasal (IN) via atomizer or IM standing
order.
101
4604-Diabetic Emergencies
 Hypoglycemia treatments shall relate to blood
glucose levels < 60 mg/dl.
 If patient is malnourished, has HIV/AIDS, receives
dialysis, is a known alcoholic, or has other grossly
impaired nutritional status, administer: Thiamine
100 mg slow IVP over one (1) minute.
102
4605-Unconscious/Altered Mental Status
 The use of this protocol requires the patient to
have a Glasgow Coma Score < 12.
 This protocol is intended to guide the
management of patients with a decreased level of
consciousness who have no history of trauma.
 Administration of Narcan® has changed to read:
If blood glucose level is > 60, administer
Naloxone 0.4 mg/minute up to 2 mg IV titrated to
restore the respiratory drive. If IV cannot be
established, administer 2 mg intranasal (IN) via
atomizer, or intramuscular (IM).
103
4605-Unconscious/Altered Mental Status
 Possible causes added as follows:
104
4606-Overdose/Toxic Ingestion/Poisoning
 This protocol was revised to combine multiple
protocols into one.
 Protocol incorporates the following:
 Alcohol
 For alcohol withdrawal with severe agitation,
tachycardia, hypertension, or hallucinations, administer
Midazolam 2 mg IV/IO/IM or 5 mg (IN) via atomizer standing
order.
 Seizures secondary to alcohol withdrawal should be
treated per 4603 Seizure Protocol.
105
4606-Overdose/Toxic Ingestion/Poisoning
 Narcotics / Opiates
 Patients who exhibit with a blood glucose level > 60
mg/dl and have suspected narcotic overdose
complicated by respiratory depression; may be
administered Naloxone 0.4 mg/minute up to 2 mg
IV titrated to restore the respiratory drive or 2 mg
Intranasal.
 Examples: Morphine, Heroin, Demerol, Dilaudid,
Methadone, Fentanyl, Oxycodone, Codeine, and others.
 Tricyclic Antidepressants
 Examples: Amitriptyline (Elavil®), Amoxapine (Asendin®),
Clomipramine (Anafranil®), Doxepin (Sinequan®,
Adepin®), Imipramine (Tofranil®) and Nortriptyline.
106
4606-Overdose/Toxic Ingestion/Poisoning
 Cholinergics
 Examples: Pesticides (Organophosphates, Carbamates)
and nerve gas agents (Sarin, Soman) are the most
common exposures.
 For serious signs and symptoms, administer
Atropine 2 mg IV. Repeat every five (5) minutes as
needed standing order.
 Calcium Channel Blockers
 Examples: Verapamil (Calan®, Isoptin®), Nifedipine
(Procardia®, Adalat®) Nicardipine (Cardene®),
Isradipine (DynaCirc®), Amlodipine (Norvasc®),
Nisoldipine (Sular®), Diltiazem (Cardizem®).
107
4606-Overdose/Toxic Ingestion/Poisoning
 For serious signs and symptoms (altered mental status,
HR < 60 bpm, conduction delays, SBP < 90 mm Hg,
slurred speech, nausea/vomiting): administer
Atropine 1 mg IV standing order.
 Beta Blockers
 Examples: Atenolol (Tenormin), Betaxolol, Carteolol
(Cartrol), Carvedilol (Coreg), Labetalol (Trandate,
Normodyne), Metoprolol (Lopressor, Toprol XL),
Propranolol (Inderal, InnoPran), Sotalol (Betapace),
Timolol (Blocadren).
 Patients with serious signs and symptoms should be
administered a 20 ml/kg fluid bolus as well as Glucagon
2 mg IV standing order for initial dose.
108
4606-Overdose/Toxic Ingestion/Poisoning
 Stimulants
 Examples: Cocaine (Coke, crack, flake, rocks,
snow),Methamphetamine (Desoxyn, crank, glass, ice,
speed), Methylphenidate (Ritalin),
Methylenedioxyamphetamine (MDA, Adam),
Methylenedioxymethamphetamine (MDMA, Eve,
Ecstasy), Methylenedioxypyrovalerone (Bath Salts, Ivory
Wave, Ivory Coast, Purple Wave, Vanilla Sky).
 Patients with tachydysrhythmias may be administered
Midazolam (Versed) 2 mg slow IV titrated to effect
standing order.
109
4606-Overdose/Toxic Ingestion/Poisoning
 Cyanide Exposure (optional)
 This protocol allows for departments to carry
medications to counteract cyanide exposure
(Cyanokit®). This is an optional equipment.
110
4607-Behavioral Emergencies
 This protocol was revised to incorporate the SAFER
mnemonic:
 Stabilize the situation by containing and lowering the stimuli.
 Assess and acknowledge the crisis.
 Facilitate the identification and activation of resources.
 Encourage patient to use resources and take actions in
his/her best interest.
 Recovery or referral: leave patient in care of responsible
person or professional.
 Commercially available soft restraints are
permitted for patient restraint.
111
4607-Behavioral Emergencies
 Chemical Restraint:
 If psychotic/behavioral agitation is suspected,
administer Midazolam 5 mg IM or IN standing order.
 If patient remains agitated or aggressive in five (5)
minutes, administer Haloperidol 5 mg IM standing
order.
 If dystonic reaction (dyskinesia) is noted secondary to
Haloperidol administer Diphenhydramine 25 mg IV or
IM standing order.
112
4608-OB/GYN
 Addition of the Apgar Scoring Chart:
113
4700 Series
 The 4700 series has been added to guide the EMS
provider in care for Children with Special
Healthcare Needs. (CSHCN)
 This series will evolve in future protocol revisions
to incorporate adults with special healthcare
needs as well.
 Children with Special Health Care Needs (CSHCN)
can present unique challenges for providers. The
caregiver is your best source of information as
they care for the child on a daily basis.
114
4700 Series
 The EMS provider needs to have a working
knowledge of the Pediatric Assessment Triangle
(PAT) as it is a general reference for each of the
4700 series protocols.
Appearance
Work of Breathing
Circulation of Skin
 The EMS provider shall read and understand the
content of each of the 4700 series protocols.
115
4700 Series
 The 4700 Series CSHCN protocols consist of the
following:
4701 General Assessment
4702 Central Venous Lines
4703 CSF Shunt
4704 Feeding Tubes
4705 Apnea Monitors
4706 Internal Pacemaker / Defibrillator
4707 Ventilator Support / BiPap
116
4901-Airway Management
 This protocol has been revised to include post
intubation management for patients that show
need for sedation/pain management to facilitate
tolerating the endotracheal tube as follows:
 Midazolam 2 mg IV/IO every five (5) minutes to a
maximum dose of 10 mg standing order. Hold for systolic
BP < 90 mmHg.
AND/OR
 Fentanyl (Sublimaze®) 50 micrograms slow IV repeated at
50 micrograms every five (5) minutes not to exceed a total
cumulative dose of 150 micrograms standing order.
Additional doses require MCP order.
117
4902-Patient Comfort / Pain Management
 Pain management in the field may be indicated
when there is isolated trauma to extremities,
severe burns, amputations, or other pain
symptoms. These patients may be treated as
follows:
 Fentanyl (Sublimaze®) 50 micrograms slow IV repeated at
50 micrograms every five (5) minutes not to exceed a total
cumulative dose of 150 micrograms standing order.
OR
 Morphine Sulfate 2 mg slow IV may repeat every five (5)
minutes up to 10 mg or until pain is relieved.
118
4903-Rapid Sequence Intubation Guidelines
 RSI is a new protocol and will be optional. Squads
that perform RSI will be required to meet the
following requirements:
 A Squad Medical Director (SMD) must apply in writing to
the WVOEMS State Medical Director for a particular squad
to be considered for the RSI program. An Memorandum of
Understanding (MOU) shall be established between the
Squad Director, Squad Medical Director, and WVOEMS
State Medical Director.
 Each individual Squad Medical Director will choose
candidates for the program.
119
4903-Rapid Sequence Intubation Guidelines
 The Squad Medical Director will be responsible for
establishing initial and continuing education, performance
improvement, etc.
 Continuing education by the SMD will be held monthly for
the first year. The Squad Medical Director should directly
observe the RSI paramedic perform an intubation and RSI
sequence once a quarter (This can be in a clinical or
classroom setting).
 The RSI protocol is for adults only at this time (12 years old
and up).
 The Squad must agree to purchase, store, and replace
the necessary medications.
120
4903-Rapid Sequence Intubation Guidelines
 Squads entering the program shall be required to have
video assisted laryngoscopy equipment.
 Squads participating in this program shall be required to
have wave form capnography available.
 Every RSI intubation is to be enrolled in the squad’s quality
assurance program.
 A minimum of two (2) Paramedics is required throughout
transport on any RSI call.
 At the 12 month point in the program, the SMD must
reapply with the WVOEMS State Medical Director to
continue the program.
121
4903-Rapid Sequence Intubation Guidelines
 Candidates shall have at least three (3) years experience as
an active and certified WVOEMS ALS EMS provider.
 All candidates shall be required to perform a minimum of
ten (10) intubations at a WVOEMS accredited training
facility utilizing simulation. These intubations must be
directly observed by a WVOEMS approved instructor
and/or the Squad Medical Director. These intubations may
also be obtained in an operating room setting, if available.
122
4903-Rapid Sequence Intubation
 This protocol is ONLY for paramedics who have
been specifically trained to perform this skill and
have approval from the WVOEMS State Medical
Director and corresponding Squad Medical
Director.
 Rapid Sequence Intubation (RSI) should only be
performed if a rapid airway is indicated, and
benefits outweigh potential risks.
 All education will be provided by the Squad
Medical Director.
123
8000 Series
 The 8000 Series consists of the following:
8102 Morgan Lens (optional)
 The Morgan Lens is a BLS skill and training shall be
provided by the Squad Training Officer prior to use.
 The EMS provider may administer 2 drops of Tetracaine
prior to irrigation.
8201 Intraosseous Placement
 The significant change to this protocol is the placement
for adult patients. The order or insertion sites for the
adult are as follows unless contraindicated: proximal
humerus, proximal tibia, then distal tibia.
124
8000 Series
8301 Continuous Positive Airway Pressure (CPAP)
 CPAP has been shown to rapidly improve vital signs, gas
exchange, work of breathing, decrease the sense of
dyspnea, and decrease the need for endotracheal
intubation in certain patients who suffer respiratory
distress from CHF, pulmonary edema, asthma, COPD, or
pneumonia.
 In patients with CHF, CPAP can improve hemodynamics
by reducing preload and afterload, however it may
cause hypotension.
125
8000 Series
 8302 Chest Decompression
 Chest decompression procedures have been revised to
only utilize mid-clavicular placement utilizing a 14 or 16
gauge, 3¼ inch IV catheter (Pediatric: 16 gauge, 1 ¼
inch).
 8401 Percutaneous Cricothyrotomy
 This protocol is utilized in any clinical situation in which
a definitive airway is necessary, and all other methods
have failed or are otherwise not indicated.
 Cricothyrotomy may be accomplished utilizing
commercially available kits such as Quick Trach I® or
Quick Trach II®.
126
8000 Series
8403 STOMA / Tracheostomy Suction Management
 The majority of adults and children with tracheostomies
are dependent on the tube as their primary airway in
patients with CHF.
 Obstruction may be due to thick secretions, mucous
plug, blood clot, foreign body, or kinking or
dislodgement of the tube. Work expeditiously and
deliberately to reestablish airway patency and support
oxygenation/ventilation.
 DO NOT wait for cyanosis, bradycardia, and/or apnea to
develop before intervening.
127
8000 Series
 Tracheal suctioning should be carried out regularly for
patients with a tracheostomy. The frequency varies
between patients and is based on individual
assessment.
 Tracheal damage may be caused by suctioning. This can
be minimized by using the appropriate sized suction
catheter and only suctioning within the tracheostomy
tube.
128
9000 Series
The 9000 series Special Operational Policies and Treatment
Protocols have minimal changes throughout consisting
mostly of format and grammatical corrections.
9203 Left Ventricular Assist Device (LVAD) was added as an
informational protocol to assist the EMS provider in
treatment priorities when encountering these patients.
When treating an LVAD patient it is critical to listen to
the patient and the caregiver.
LVAD patients should rarely have CPR performed.
LVAD patients are rarely pronounced in the field.
There will always be an emergency contact number on
the LVAD control unit.
LVAD patients require transport to an LVAD facility.
129
Appendix
The 2015 protocols have an appendix section that can be
easily amended when necessary.
The appendix section consists of the following:
Appendix A – Fibrinolytic Checklist
Appendix B – Diversion Alert Status Form
Appendix C – Pediatric References
Appendix D – Assessment Mnemonics
Appendix E – Glasgow Coma Scale
Appendix F – Approved Abbreviations
Appendix G – Cincinnati Prehospital Stroke Scale
Appendix H – EMS Patient Care without
Telecommunications
130
131
Combi-Vent / Duo-Neb
 Class: Sympathomimetic, Parasympatholitic
 Dosage: Is a unit dose of Albuterol 2.5 mg mixed
with a unit dose of Ipratropium Bromide 0.5 mg
(Combi-vent / Duo-Neb®) via nebulizer.
 Actions: Combination of beta2 and anticholenergic
effects.
 Indications: Relief of bronchospasm in adult
patients with reversible obstructive airway disease
and acute attacks of bronchospasm.
132
Combi-Vent / Duo-Neb
 Contraindications: Prior hypersensitivity to any of
its components or to atropine, soy lecithin,
bromide or flourocarbons and cardiac dyshythmias
associated with tachycardia.
 Side Effects: Restlessness, apprehension, dizziness,
headache, blurred vision, dry mouth, palpitations,
increase in BP, dysrhythmias, increased hypoxemia.
133
Tetracaine
 Class: Topical ophthalmic anesthetic
 Dosage: 2 drops in the affected eye prior to
irrigation.
 Actions: Superficial anesthesia. Inhibits
conduction of nerve impulses from sensory nerves
 Indications: Patient comfort prior to eye irrigation.
134
Tetracaine
 Contraindications: Known hypersensitivity or open
globe injury (i.e. laceration to the eyeball).
 Side Effects: Burning or stinging sensation,
irritation, and possible epithelial damage and
systemic toxicity.
135
Haloperidol (Haldol®)
 Class: Antipsychotic agent, major tranquilizer
 Dosage: 5 mg IM/IN. If dystonic reaction occurs,
follow with 25 mg of Benadryl.
 Actions: Haloperidol is a potent, long-acting
Butyrophenone derivative. Haloperidol interferes
with the effects of neurotransmitters in the brain
which are the chemical messengers that nerves
manufacture and release to communicate with
one another.
136
Haloperidol (Haldol®)
 Indications: Used for management of
manifestations of psychotic disorders and for the
treatment of agitated states in acute and chronic
psychoses.
 Contraindications: Combativeness from trauma,
Hypersensitivity to Haloperidol, Parkinson's
disease, seizure disorders, coma, alcoholism, severe
mental depression, CNS depression, Thyrotoxicosis,
and cocaine overdose.
137
Haloperidol (Haldol®)
 Side Effects: Parkinson like symptoms, restlessness,
lethargy, headache, exacerbation of psychotic
symptoms, tachycardia, hypotension, hypertension
(with overdose), nausea, vomiting, bronchospasm,
laryngospasm, respiratory depression, dry mouth,
hyper-salivation, drooling. Extrapyramidal reactions
(cervical and lumbar muscle spasms) may occur.
138
Midazolam (Versed®)
 Class: Sedative Hypnotic
 Dosage: 2 mg IV/IO and 5 mg IM/IN
 Actions: Short acting benzodiazepine with sedative
hypnotic and amnestic properties.
 Indications: Adults requiring sedation such as
intubated patients, seizure patients, and
combative patients.
139
Midazolam (Versed®)
 Contraindications: Hypotension, acute narrowangle glaucoma, known hypersensitivity to
Midazolam
 Side Effects: Respiratory depression, apnea,
hypotension, amnesia
140
Magnesium Sulfate
 Class: Electrolyte
 Dosage: 1 gm diluted in 10 ml NS administered
over 5 - 20 minutes
 Actions: Central Nervous system depressant.
Replaces electrolyte deficiencies.
 Indications: Eclampsia and Torsades des pointes
141
Magnesium Sulfate
 Contraindications: Myasthenia Gravis and
impaired renal function (i.e. to include dialysis
patients).
 Side Effects: May cause: flushing, sweating,
itchiness and rash, drowsiness, headache,
respiratory depression, hypotension, bradycardia,
and other arrhythmias.
142
Diltiazem (Cardizem®)
 Class: Calcium Channel Blocker, antidysrhythmic
 Dosage: 0.25 mg/kg slow IVP repeated in 15
minutes at 0.35 mg/kg slow IVP.
 Actions: Binds to open calcium channels
preventing repolarization until dissociation.
Decreases SA nodal discharge, AV nodal
conduction, afterload and myocardial contractility.
143
Diltiazem (Cardizem®)
 Indications: Stable uncontrolled new onset atrial
flutter or fibrillation. Second line medication for
stable narrow complex tachydysrhythmias.
 Contraindications: Known hypersensitivity, shock
or hypotension, W.P.W., sick sinus syndrome, high
degree heart block (2nd type II or 3rd degree),
heart failure and ventricular tachycardia.
 Side Effects: Hypotension, dysrhythmias, nausea
and vomiting, headaches.
144
Labetalol
 Class: Nonselective beta-blocker, Selective alpha-1
blocker (inhibits peripheral vasoconstriction).
 Dosage: 10 mg slow IVP over 1 - 2 minutes
repeated in 10 minutes at 20 mg slow IVP.
 Actions: Lowers blood pressure by decreasing
cardiac output and causing vasodilation. It is
metabolized by the liver and excreted by the
kidneys.
145
Labetalol
 Indications: Acute management of hypertensive
crisis.
 Contraindications: Asthma/COPD with respiratory
symptoms, known sensitivity to labetalol,
bradycardia, CHF, heart block, cardiogenic shock.
 Side Effects: Symptomatic orthostatic hypotension
(do not let patients stand after administration),
bradycardia, hypotension, dyspnea, fatigue.
146
SUMMARY
 It is extremely important all EMS providers read
through each individual protocol respectively.
 These protocols allow all West Virginia EMS
providers to provide better, more comprehensive,
care to our patients resulting in favorable
outcomes.
 Better care is accomplished through new
treatment options, new medications, evidence
based treatment modalities, and a
comprehensive understanding of the protocols.
147